Clinical risk managment and the ethics of open disclosure : part 2 : implications for the nursing profession

Patient safety experts and other authorities have strongly postulated the open disclosure of errors and adverse events to patients and their nominated support persons as an essential component of effective clinical risk management in health care. Commentators also contend that ‘when things go wrong’, openly disclosing such events to the patient is simply ‘the right thing to do’. Important questions about the ethics of open disclosure remain, however. Is openly disclosing errors and adverse events to patients necessarily ‘the right thing to do’? Do hospital authorities and health care professionals always have an overriding duty to openly communicate with patients and their families when thing go wrong? If patients do not suffer any material harm when a mistake is made, should they or their nominated support persons still be told? Are there overriding moral considerations that might justify non-disclosure in certain circumstances? Despite the obvious importance of these issues and their possible implications for the nursing profession, they have not been comprehensively explored in the nursing literature. An important aim of this article (the second of a two-part discussion) is to contribute to the positive project of redressing this oversight.

Client managment on house projects : faciliating client learning for successful architect-client relationships

This paper reports the findings of a study which examined architect-client relationships on house projects with a focus on the supportive role of architects in helping clients deal with project issues. Habitus theory explains that the nature of architecture as a specialised activity places architects within an architectural habitus, distinguishing them from clients who are not trained in the field, which is at the heart of the problematic architect-client relationship. An underlying premise was that habitus shock, that is, a mismatch between the architect and client's habituses Occurs as they enter into a relationship on the house project. Using the qualitative approach underpinned by the constructivist perspective for data collection and analysis, eight in-depth interviews were conducted across five case studies of successful architect-client relationships. The narrative inquiry approach was used to establish the extent to which habitus shock occurred and to describe the stages involved in the client's adjustment process during habitus shock. The findings indicate that habitus shock occurred on all five case studies, which resulted in client learning, enabling clients to function with competency in the unfamiliar environment. Client learning achieved during habitus shock was directly linked to the amount of difficulty experienced. This study has refined our understanding of the architect-client relationship on house projects by exploring more deeply client behaviour and the ways in which clients successfully deal with difficulties on house projects rather than simply identifying the uncertainties and conflicts that occur on projects. The findings demonstrate that client learning during habitus shock is a characteristic of successful relationships. One of the most significant outcomes of thi s study is that it demonstrated the potential to facilitate client learning during habitus shock to contribute to the development of successful architect-client relationships.

Is near to . . . and is . . . distant from : exegetical manoeuvres in Janet Frame’s The Carpathians

This paper argues that Janet Frame’s 1988 novel, The Carpathians, can be read as a series of manoeuvres operating at the frontiers of exegesis and fiction. The overall effect of these manoeuvres is to interrogate the conditions of an exegetical (or literary critical) engagement with Frame’s writings. In particular, The Carpathians drills down into the metaphorics of one of the key notions of literary criticism: critical distance. Critical distance is a catch phrase of exegesis, as well as of literary criticism, because it serves to appropriately position the exegete (like the literary critic) as both near to and distant from the object of study: the literary text. However, Frame’s fictional/Scientific concept of the Gravity Star deconstructs the metaphorics of distance and, by extension, critical distance itself, by suggesting a para-doxical relationship of propinquity and remoteness. The Gravity Star is ‘both relatively close and seven billion light years away.’ Thus, Frame introduces chaos into language and logic, with the dual effect of undermining exegetical activity (which depends on the  metaphorics linked to critical distance) and of creatively multiplying the meanings of The Carpathians. In this way, Frame’s novel replaces conventional exegesis with creative exegesis. My paper also looks at the games Frame plays, in this novel and in Towards Another Summer (2007), with Roland Barthes’s notion of the ‘death of the Author.’ Like critical distance, the Author is a prop for exegesis that certain manoeuvres of writing can undermine, thus allowing the literary text to reproduce itself on an interior plane.

Nature, extent and antecedents of risk managment practices in knowledge-intensive firms

This study provides empirical evidence on the nature and extent of risks faced by Small to Medium-Sized Knowledge Intensive Firms (SMKIFs) and the risk management approaches adopted by them. The study also assesses the effects of selected organisational factors such as industry, entity size and risk governance leadership on the commitment by SMKIFs to using an Enterprise Risk Management (ERM) approach. Data was obtained through a questionnaire survey of SMKIFs in the state of Victoria, Australia which were either in the bio-technology (bio-tech) or the accounting and legal (business services) industry sectors. Based on a total of 104 (13%) useable responses from senior managers in charge of risk management, some of the key findings include the identification of the top three risks faced by SMKIFs being (i) potential damage to firm’s reputation, (ii) inability to recruit and retain workers who have appropriate skills and expertise, and (iii) increase in costs. Interestingly, while 51% of the respondents described their firms as being willing to or keen to take risks, 38% saw their firms as being either preferring not to take risks or refuse to take risks, with the remainder of the firms (11%) viewed as neutral. The data also indicates that more than half of the respondent firms (54%) had established either a complete or a partial ERM system. Further, data analysis based on a binary logit regression model indicates bio-techs, firm size and directors’ support of risk management as key predictors of ERM implementation in SMKIFs.

‘Coded in a code of the world' : minor literature and the time-image hidden in Janet Frame’s late fiction?

This article seeks to demonstrate how Janet Frame’s late fiction can be read as a theoretical engagement with the conceptual investigations of Gilles Deleuze and Félix Guattari, especially the notions of minor literature and the in her late novels Living in the Maniototo (1981) and The Carpathians (1989). For this reason, my approach must be sharply distinguished from a more commonplace analogical framing of Frame or a simple one-to-one translation of her fiction into alternative terms. By weaving theory through her fiction, Frame makes a significant contribution to literature that responds to the still-emerging field of Deleuzean literary critical theory.

Rethinking political process in technological change : socio-technical configurations and frames

The political process perspective has done much to enhance our understanding of the organizational effects of technological change as a negotiated outcome reflecting the political and power dynamics of the adopting context. In so doing, we suggest, technology has been marginalized as an analytical category and the problem of change agency, although better understood, remains largely unresolved. This article addresses these issues through the articulation of the concepts of socio-technical configurations and technological frames and explores their utility in understanding change agency through an action research project. The project sought a novel form of 'socio-technology' transfer, taking ideas and concepts of 'human-centered' manufacturing embodied in team-based cellular manufacture from a European context into three firms in Australia.

Analysis of the cost performance of structural building frames in Australia

The significance of this research is that it is the first comprehensive analysis of cost performance across Australia. It is well known that measuring cost performance is not an easy task; comparisons of building projects on a `like-for-like’ basis are uncommon, and rarely occur in the real world. However, this paper analyses 120 different structural frame models that represent various; structural designs, construction methods, grid spans, and locations.

The research produced price models that were representative of structural frames used in medium-rise non-residential buildings. It is based on pricing a number of standard building frame designs in five Australian cities. The results represent the cost of producing the same building in different locations, using similar building construction techniques. By utilizing a standard model, project variables like building quality, ground conditions and access were eradicated, thereby facilitating an unbiased comparison of cost performance. I addition, the results are an indicator of building productivity based on costs per square metre of various construction types.

This research provides the Australian industry with robust data about the relative cost performance of various structural building frames. In addition, this research has wider implications because the models may also become useful data for the measuring relative cost performance in other countries.

Locating frames of reference for information systems : a position paper

Frame analysis has been applied in Information Systems (IS) research to generate understanding of such issues as organisational change and IS implementation. Frames are the unconscious interpretive schemas that people, or groups of people, use to interpret their surroundings, determine what is important, and guide their actions. While framing has been used as a theoretical lens in IS research into organisations, there has been no analysis to date of how frames may play a role in the IS field itself. This paper argues that is relevant and insightful to examine the IS discourse from a framing perspective. In order to demonstrate the potential value of such an approach, a subset of a collection of articles from six journals in the senior scholars’ basket of journals was analysed in an exploratory attempt to locate the frames of reference that predominate in the IS discourse. Three levels of framing were identified and a provisional schema is proposed. We suggest that further investigation of the schema, the frames and their application will provide opportunity for critical reflection on the nature of Information Systems as an academic discipline. Such critical self-examination may even foster purposive frame breaking, in support of recent calls for transformation in the IS field.

Frames

'The film is a mixture of flickery, letraset, light, scratching and hand-drawn colour. So rapid is the movement that it makes you wonder at times if you are looking at an image or its afterimage. Could a film like Frames be damaging to your retinam or neurological functions? if you sat in front of this type of film long enough, would it send you on a trip? Could it awaken a patient out of a coma? After a confronting seven minutes I felt exhausted and slightly frazzled. Such is the power of the film' Glen Hannah in Filmviews Number 130 p28 1986

Construction cost performance of structural frames in Australia

This research is concerned with the comparative cost of building structural frames in Australia. The research has been undertaken to evaluate the cost performance of a number of technologies that are typically used in medium-rise commercial buildings of ten storeys. The research methodology is based on pricing a number of standard building frame designs in five Australian cities. The results represent the cost of producing the same building using different building construction designs. By utilising a standard model, project variables like building quality, ground conditions and access were eradicated, thereby facilitating an unbiased comparison of cost performance. The second stage of the research invoiced a focus group of industry experts who were asked to validate the results of the cost study. In addition, participants of the focus group were asked to comment on the preferred construction practice for each of the typical building designs. Results suggest that post-tensioned in situ concrete frames have the best cost performance for most buildings. However, other designs can have good cost performance under some circumstances. Findings suggest that the Australian construction industry has long cultural preference for the use of in situ concrete in structural frames.